Business models for the enhancement of telemedicine implementation projects in the rural parts of South Africa Overall aim and research objectivesThe overall aim of this project is to enhance the success rate of telemedicine implementation projects in rural parts of South Africa in order to contribute to the sustainable efficiency and effectiveness of the delivery of public healthcare services and education within a rural context. The objectives of this study is firstly to determine why certain telemedicine projects in the Western and Eastern Cape has not (yet) been implemented successfully and secondly to learn from this in order to develop and apply business models that can be used to in the planning, implementation and evaluation of future projects.

Main research questionWhat are the determinants of successful telemedicine implementations within the context of rural Western and Eastern Cape provinces of South Africa and how could the inclusion of these determinants be facilitated when implementing future telemedicine projects within rural context in South Africa?

Specific research objectives1.Frame the determinants for the successful telemedicine implementation within context of a public rural health system, like South Africa’s. 2.Identify the prevalence or absence of these determinants with respect to the unsuccessful / not yet successful implementation of telemedicine technology in the Western and Eastern Cape. 3.Design business models to be used as input to future telemedicine projects in rural areas, contributing to the success thereof. 4.Assess the risks by current telemedicine projects and projects planned for the near future. Use these determinants of successful telemedicine implementation – as framed by the business models - to facilitate future project implementation.

The South African government is committed to providing basic healthcare to all South African citizens, of which about 50% is situated in rural areas (Sorenson,2008). To do this, the government identified telemedicine as a strategic tool to improve delivery of equitable healthcare and educational services (Benatar, 2004).

A telemedicine workstation was developed by the Faculty of Engineering, Stellenbosch University, in collaboration with the Medical Research Council (MRC), with the purpose of allowing nurses to transmit patient data for e-consultation by specialists at other hospitals to eliminate the need for the patient to physically go the hospital. This is done primarily for purposes of clinical consultations - and not intentionally for training purposes. This workstation was piloted at Grabouw clinic and is destined for deployment in other areas. After initial success, this workstation was stopped being used. Similar workstations are ready to be deployed, through the mediation of the MRC to clinics in the Western and Eastern Cape. Unfortunately these workstations are perceived by many to be a “white elephant”. One of the outcomes of this project will be to determine if this perception is valid or whether it is a perception due to the absence of other determinants of successful telemedicine projects.

Mars (2009) reports that at the Walter Sisulu Medical School in the Eastern Cape Province, the telepathology and teledermatology services are provided through an iPath server located in Umtata. An innovative wireless solution, developed by the CSIR, was piloted in a rural Eastern Cape clinic staffed by a nursing sister. According the Mars (2009) the activity in the Eastern Cape has resulted in the formation of an active telemedicine committee within their DoH. They have set up an education centre with Internet and videoconference facilities in East London, and they are embarking on a large-scale project linking 23 sites, focusing on teleradiology, teledermatology and tele-spirometry. The project is not yet fully functional, and has yet to be evaluated.

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